BACKGROUND: Implications for the Ageing Population and the Communities they live in

Health has been declared a fundamental human right. This implies that the state is responsible for attain the highest standard of health to the citizens. National governments all over the world are striving to expand and improve their healthcare services. The present concern, in both developed and developing countries, is not only to cover the whole population with adequate health care services, but also to secure an acceptable standard of Health for all, through the well delivered primary health care programs.

Currently there are a little over 100 million elderly in India and many of them have no means of support. As per the Planning Commission, India’s elderly (60+years) are projected to double to almost 198 million by 2020. An ageing population places a greater demand on the health services of the community. In a rapidly graying world, healthy aging is vital for countries and is a prerequisite for economic growth. The predicted explosion of non-communicable diseases such as cardiovascular diseases, cancer, and depression in the ever increasing number of older persons globally, will result in enormous human and social costs unless preventive action is taken.

This expected alteration of the age pyramid, thus poses significant new challenges for governments, societies, and families in the 21st century. Ageing developing countries are slated to face a heavy double burden of infectious and non-¬communicable diseases, yet they often lack significant resources, including comprehensive ageing policies, to cope.

The modern philosophy is that the old must continue to take-up their share of responsibilities and depend on the entitlements, which are an essential for remaining an active member of the community. The World Health Organization suggests that the socio-economic impact of ageing can only be addressed if countries, regions and international organizations enact “Active Ageing” policies and programmes that enhance the health, independence and productivity of older citizens.

In a developing country like India the situation is not favorable for its elderly population. 5% of the aged population report disability – loss of vision (52%), movement (27%), hearing (13%), mental disorders (5%) and speech (3%). About 30% of older persons live below the poverty line and another 33% just marginally over it. For a large number of older persons and the communities they live with, essential health-care and social support services are unavailable, inaccessible and/or unaffordable. For individuals to contribute to society, good health is a key facilitator. However, good health often reflects the degree of support one receives from society. It is therefore crucial to ensure that older persons and the communities they live in with have every opportunity to remain active. Just as health sustains activity, an active life predicates the best chance of being healthy.

PROJECT – Mobile Health Unit

The Mobile Health Unit (MHU) initiative is HelpAge India’s flagship programme. This programme has immediate short-term impact towards improvement in the quality of life of our marginalised beneficiaries. Our MHUs address the problems of unaffordability, inaccessibility, and non- availability of basic essential healthcare to poor elderly. The programme fulfils a vital need of health in the lives of our beneficiaries. From 2 units launched between 1982 and 1994, HelpAge India today runs a fleet of about 98 units and our footprint continues to grow bringing healthcare to the doorsteps of India’s poorer elders.

HelpAge India’s MHU program has indeed proven to be a very effective one, in that, it not only provides health security which is a direct and discernible effect, but also provides emotional and to an extent financial security to the beneficiaries. Its efficacy can be judged from the fact that the Central Government has accepted the concept of Mobile Health Units as a highly effective means of delivery of health services, and has been supporting some of HelpAge India’s existing MHUs across India. HelpAge India proposes the provision of primary healthcare to disadvantaged elderly persons and the community through 3 Mobile Health Unit (MHU) in the states of Himachal Pradesh, Madhya Pradesh & Maharashtra at location proximate to CIPLA Facilities:

The village sites schedule or location is determined as proposed by the local CIPLA office in consultation with HelpAge India.

TARGET BENEFICIARIES

The MHU project is aimed at providing healthcare at door step with special focus to the elderly persons (above 60 years) as well as the communities they live in—in the proposed operational areas—that have limited or no access to healthcare due to either poor and inadequate existing healthcare facilities or unaffordable due to lack of financial resources or other physical and mobility reasons.

Though the treatment to people below 60 years is not denied, positive preference and encouragement is given to the senior members who suffer for isolation, discrimination and neglect. As a guideline, HelpAge India also ensures that at least 50% beneficiaries belong to economically weaker sections (EWS) of the society.

The mobile health program is a proven intervention in delivering quality healthcare to vulnerable and unreached sections of the society. It overcomes barriers that the elderly and vulnerable sections encounter in accessing ‘for free’ services.

HEALTHCARE SERVICES PROVIDED BY HELPAGE INDIA’S MOBILE HEALTH UNITS

The MHU is designed to provide Primary Healthcare services for the elderly, namely:

Free treatment: The doctor examines patients and, based on standardize medical equipment set, clinically diagnoses them and prescribes medicines. Where required, the patients are referred to pathological laboratories for detailed investigation or to a specialist in serious cases.

Free medicines: The MHU stocks medicine for all common ailments among the elderly including Hypertension, Diabetes, Arthritis, etc. These medicines are issued to the patients free of cost by the Pharmacist on the basis of the Doctor’s prescription. The Pharmacist also explains the dosage of medicines, supplementary nutrition intake and their side effects, if any, to the patients.

Basic diagnostics: The MHU van is equipped with basic diagnostic equipment such as stethoscope, BP apparatus, thermometer, weighing machine etc for checking the vital signs. In addition, there is a ‘glucometer’ for blood sugar testing.

Home visits by doctor (in case of bedridden patients): The doctor and the paramedic team conduct weekly visits the houses of bedridden elders who otherwise cannot approach or be brought to the vehicle. The doctor and paramedic team examines & clinically diagnoses the problems presented by the elder patient or caregivers and prescribes medicines and advice the patient and their caregivers.

Counseling for patients, elders, family members and caretakers: The counselor and the doctor provide necessary advice and counseling to patients and caretakers on various ailments and home care. The project team also conducts regular counseling sessions on various aspects for healthy ageing i.e. (a) diet and nutrition; (c) weight reduction; (b) regular exercise; (d) smoking; (e) alcohol; (f) social activities. By adopting a healthier lifestyle, the risk of a whole range of diseases can be reduced.

Community awareness on the rights of the elderly: Every person has the right to freedom and dignity and the right to be treated by respect and fairness by others. A positive, supportive and caring attitude by family, friends, caretakers and the community will help the elderly to continue as integral, respected and valued members of society. Creating awareness in the community especially among the younger generation helps to sensitize them on the various aspects of taking care of the aged and in long term will also help them in preparing for their old age.

Other value added services include Referral services / facilities viz.
Referral linkage with local health providers: The team promotes / initiates linkages with private as well as government health care facilities so as to ensure that the required services would be available on demand. The linkage between the HelpAge India beneficiaries and these identified institutions would ensure accessibility and affordability of the services.

Linkage with Govt. schemes and programmes: This initiative aims to increase awareness among the elderly poor about various social security, food security and habitat security schemes, and thus enabling them to advocate/ demand their rights. We realize that elderly people need support to avail these schemes. The MHU plays a facilitating role in linking them with the local and district administration and also collecting the information from the government offices and disseminating this information to the concerned/eligible beneficiaries thus improving their access to social welfare schemes.

THE MHU TEAM

All HelpAge MHUs are equipped with the following team of personnel:

EXPECTED POSITIVE OUTCOMES

The current state of the aged in the country necessitates society to promote interventions in favor of older persons, which would facilitate them to active lives to the extent possible and medical support to live with dignity and respect.